RU2696684C1 - Method for determining types of cognitive disorders in patients with cerebral microangiopathy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely neurology, and can be used in determining types of cognitive disorders in patients with cerebral microangiopathy. That is ensured by neuropsychological testing, evaluating cognitive memory functions by delayed reproduction of 10 words, cerebral control functions (CCF) by testing of switchability – visual-motor coordination test in seconds, inhibition by Stroop test: number of responses in 45 seconds, productivity – speech fluency test for 60 seconds and working memory – a test for direct and reverse repetition of numbers in points, as well as praxis/gnosis by means of a clock drawing test with subsequent assessment of severity of deviation from the standard of sigma test results. A deviation of +1.5σ corresponds to a moderate, and +2.5σ – a marked disturbance of cognitive memory functions. According to any of the used tests, the CCF has switchability, inhibition, productivity or working memory and praxis/gnosis. If the cognitive memory functions are +1.5σ or +2.5σ, and the CCF and praxis/gnosis parameters are normal, a monofunctional amnestic type of cognitive disorders is stated. If the value of CCF is +1.5σ or +2.5σ, and the memory and praxis/gnosis parameters are normal, a monofunctional dysregulation type is stated. If the value of praxis/gnosis is +1.5σ or +2.5σ, and memory and CCF values are normal, monofunctional apracto-gnostic type is determined. If the memory value is +2.5σ, and the CCF and the praxis/gnosis +1.5 σ – the polyfunctional amnestic type of cognitive disorders is determined. If CCF is +2.5σ, and memory and praxis/gnosis +1.5σ – polyfunctional diarrheal type is determined. If the value of praxis/gnosis +2.5σ, and that of memory and CCF +1.5σ – polyfunctional apracto-gnostic type is determined. If the memory, CCF and praxis/gnosis +1.5σ or +2.5σ – polyfunctional mixed type of cognitive disorders is determined.

EFFECT: method enables reliably and accurately determining types of cognitive disorders in patients with cerebral microangiopathy by refining monofunctional and polyfunctional types.

1 cl, 1 dwg, 1 tbl, 7 ex

Description

The invention relates to medicine, in particular to neurology and can be used to determine types of cognitive disorders in patients with cerebral microangiopathy.

Cerebral microangiopathy (CMA) (in Russia - discirculatory encephalopathy, CMA, abroad - cerebral microangiopathy, small vessel disease) is one of the leading causes of cognitive impairment (CR). Morphological data are close to the opinion of leading foreign researchers, who estimate the participation of CMA in the development of dementia at the level of 45%. Significant achievement in the possibility of consolidating the efforts of scientists and standardizing research on clarifying the role of CMA in the development of the Kyrgyz Republic was the International Neuroimaging Standards for Research into Small Vessel Disease and Its Contribution to Ageing and Neurodegeneration adopted in 2013 by the international MRI expert group. - STRIVE - STandards for ReportIng Vascular changes on nEuroimaging ”, 2013) [Wardlaw, JM, Smith, C., Dichgans, M. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. The Lancet Neurology 2013; 12 (5): pp. 483-497].

At present, the intravital verification of mixed forms of CR due to neurodegeneration and CMA is difficult, as is the understanding of the mechanisms of mutual influence on the development of CR. The assumption of their comorbidity, as a rule, is based on the characteristics of the CR, namely, the simultaneous presence of amnestic disorders characteristic of Alzheimer's disease and characteristic of CMA - executive dysfunction disorders, as well as the mismatch of the severity of CR and the severity of vascular changes in the brain according to MRI.

Cognitive impairment is a key manifestation of CMA, which largely determines the severity of patients. They can serve as the most important diagnostic criterion for CMA and are perhaps the best guideline for assessing the dynamics of a disease. Correction of cognitive impairment in patients with CMA is often critical to improve the quality of life of the patient and his relatives [Levin OS, Sagova MM, Golubeva LV. Factors affecting the life factors of patients with dyscirculatory encephalopathy with moderate cognitive impairment // Russian Medical Journal. 2006; 2].

A known method for the diagnosis of cognitive impairment in patients with cerebral microangiopathy using a screening tool that has become popular in recent years - the Brief scale of mental status (MMSE) [Hachinski V., Iadecola C, Peterson R.C. et al. NINDS and Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards // Stroke. 2006; 37: 2220-2241]. However, this method is not sensitive enough to the assessment of the controlling functions of the brain and may cause incorrect diagnosis. Also, the cause of a false negative diagnosis of cognitive impairment in CMA may be the use of only one test (for example, the “clock drawing” test), which does not allow us to evaluate the entire spectrum of cognitive functions.

There is also a method for determining the types of cognitive disorders in patients with cerebral angiopathy by evaluating them with a neuropsychological research method. In everyday clinical practice, the so-called screening psychometric scales are used, which are a set of the simplest samples for various aspects of cognitive activity: memory, attention, intelligence, praxis / gnosis, speech, orientation, etc. The generally accepted standard for screening for cognitive impairment is testing on the Mental Health Assessment Briefing Scale (KSHPS) [Folstein M.F., S.E. Folstein, McHugh P.R. Mini-Mental State: a practical guide for grading the mental state of patients for the clinician. J Psych Res, 1975, V.12, pp 189-198]. However, this technique was originally developed for the diagnosis of Alzheimer's disease. The tasks included in this technique evaluate the functions of the posterior cerebral cortex, such as memory, orientation, counting, speech and constructive praxis. Patients with CMA, even with significant severity of cognitive impairment, can receive a high score for CWPS, since CMA primarily affects the anterior regions of the brain. Therefore, in patients with concomitant cardiovascular diseases, it is advisable to use neuropsychological tests sensitive to frontal dysfunction. This source of information is considered as the closest analogue.

Thus, currently there are no recommendations for the diagnosis of mixed forms, characterized by simultaneous degenerative and vascular lesions.

The technical result consists in increasing the accuracy and reliability of determining the types of monofunctional (isolated violation of a certain cognitive function) and multifunctional cognitive disorders in patients with cerebral microangiopathy.

The technical result is achieved by the fact that the determination of types of cognitive disorders in patients with cerebral microangiopathy is carried out by neuropsychological testing, while neuropsychological testing evaluates the cognitive functions of memory by means of a delayed reproduction of 10 words, controlling brain functions (UVM) by testing switchability - a visual test motor coordination in seconds, inhibition by means of a scab test: number of answers in 45 seconds, productivity - fluency test speech in 60 seconds and working memory - a test for the direct and reverse repetition of numbers in points, as well as praxis / gnosis through the test of drawing hours in points with subsequent assessment of the severity of the deviation from the norm of the test results by sigma, with a deviation of + 1.5σ correspond moderate, + 2.5σ - pronounced impairment of cognitive memory functions, UFM according to any of the tests used - switchability, inhibition, productivity or working memory and praxis / gnosis, and with a value of cognitive memory functions + 1.5σ or + 2.5σ, a display UFM and praxis / gnosis factors normally determine a monofunctional amnestic type of cognitive impairment, with a UFM value of + 1.5σ or + 2.5σ, and memory and praxis-gnosis parameters normally determine a monofunctional dysregulatory type, with a praxis / gnosis value of +1, 5σ or + 2.5σ, and the memory and UFM indicators normally determine the monofunctional apracto-gnostic type, with a memory value of + 2.5σ, and the UFM and praxis / gnosis + 1.5σ determine the multifunctional amnestic type of cognitive impairment, with a UFM + value 2.5σ, and memory and praxis / g ozis + 1.5σ determine the multifunctional dysregulatory type, with the praxis / gnosis value + 2.5σ, and memory and UVM + 1.5σ determine the multifunctional apracto-gnostic type and the value of memory, UVM and praxis / gnosis + 1.5σ or + 2.5σ determine a multifunctional mixed type of cognitive impairment.

The method is as follows.

The following cognitive functions (CF) are evaluated in a patient.

1) Memory - a test for memorizing 10 words and their delayed reproduction [Luria A.R. Higher cortical functions of man. Second revised edition. M .: Publishing house of Moscow University. 1969. 503 p.]. Moreover, 10-7 words is the norm of reproduction, 6 is a moderate violation of the CR, 5 or less is considered as a pronounced violation of the CR.

2) UFM by its components: by testing switchability (Trail Making Test BA-A (TMT BA-A) - test for hand-eye coordination in seconds [Lezak MD, Howieson DB, Loring DJ, Fischer JS Neuropsychological Assessment. Oxford University Press , 2004], with a switchability of 75 seconds or less is considered normal, 76-96 as moderate violations of the CR, 97 and more - as expressed violations of the CR, inhibition - Stroop test: the number of responses in 45 seconds [Stroop JR Studies of interference in serial verbal reactions. J. Exp. Psychol. 1935; 18, 643-662], and the number of responses 30 or more is normal, 29-21 is moderate for a violation of the Kyrgyz Republic, and 20 answers or less - a pronounced violation of the Kyrgyz Republic, productivity testing - a fluency test: the number of words in 60 seconds, with 10 words or more in 60 seconds corresponds to the norm, 9-7 words in 60 seconds corresponds to a moderate violation of the Kyrgyz Republic, and 6 words or less in 60 seconds - a pronounced violation of the CR, testing of working memory - a test of direct and reverse repetition of numbers [Wechsler D., Coalson DL, Raiford SE WAIS-IV technical and interpretive manual. San Antonio, TX: Pearson. 2008], and the test for the direct and reverse repetition of numbers is carried out as follows: the patient is sequentially read two rows of numbers that must be repeated in the forward and reverse order, respectively, with the correct naming of two numerical series, 2 points are assigned, with the correct naming of one numerical series, 1 is assigned point, and less than one number series 0 points;

3) Visual-spatial gnosis / praxis - a clock drawing test: constructive praxis (self-image of the drawing according to the instructions) and visual-spatial gnosis (correct placement of the hands with the time set by the researcher) [Sunderland T., Hill J.L., Mellow A.M. et al. Clock drawing in Alzheimer's disease. A novel measure of dementia severity. J Am Geriatr Soc. 1989; 37 (8): 725-9]. The patient himself, without prompts, from memory should draw a dial in the form of a circle, correctly arrange all the numbers and arrows indicating the time. In the presence of cognitive impairment, memory problems, the patient makes inaccuracies and errors. The test result is evaluated as follows: ≥8 points - the norm, a circle is drawn, numbers in the right places, the arrows show the set time; 7-5 points - minor inaccuracies in the location of the arrows; or errors in the location of the arrows are more noticeable (one of the arrows deviates more than an hour); either both hands show the wrong time; either the arrows do not show time (time is circled); either the wrong arrangement of numbers on the dial (the numbers follow in the reverse order, that is, counterclockwise, or the distance between them is not the same); ≤4 points - the integrity of the watch is lost, some of the numbers are missing or located outside the circle; either the dial and numbers are no longer connected to each other; or the patient attempts to complete the task, but to no avail; or the patient does not attempt to follow the doctor’s instructions.

, что означает корень из суммы квадратов разниц между элементами выборки и средним, деленной на количество элементов в выборке. Расчет производят по встроенной функции вычисления стандартного отклонения в Microsoft Excel (СТАНДОТКЛОН). В соответствии с критериями международной ассоциации сосудистых поведенческих и когнитивных расстройств VASCOG: отклонение +1,5σ соответствуют умеренному, 2,5σ - выраженному нарушению КФ. В качестве нормы использовались данные, полученные в группе контроля у 23 здоровых добровольцев, сопоставимых по возрасту, полу (15 ж., ср. возраст 58±6 лет) и уровню образования без МРТ признаков какой-либо патологии головного мозга и отсутствия когнитивных жалоб. Для умеренного и выраженного нарушения КФ данные были собраны и обработаны у 61 больного (65 ж., ср. возраст - 61±6,6 лет) (см. таблица 1). У всех больных анализировались классические факторы риска цереброваскулярных заболеваний: АГ, сахарный диабет (СД), гиперхолестеринемия, ожирение и курение. Степень АГ оценивалась согласно рекомендациям рабочей группы по лечению АГ Европейского Общества Гипертонии и Европейского Общества Кардиологов (ESH/ESC 2013): АГ 1 степени систолическое артериальное давление (САД) 140-159 и/или диастолическое АД (ДАД) 90-99 мм рт.ст., АГ 2 степени - САД 160-179 и/или ДАД 100-109 мм рт.ст., АГ 3 степени - САД≥180 и/или ДАД≥110 мм рт.ст. СД оценивался качественно по его наличию/отсутствию. Гиперхолестеринемия определялась как случайно выявленное лабораторное повышение холестерина (>6,2 ммоль/л) или компенсированные цифры на фоне лечения. Ожирение диагностировалось на основании результатов измерения индекса массы тела (ИМТ).The duration of the examination of the patient is 40-60 minutes. In cases where the patient cannot complete the task, he is assigned the minimum value for this test. The severity of the violation of each CF is determined by the deviation from the norm in σ, calculated by the standard deviation formula

, which means the root of the sum of the squared differences between the elements of the sample and the average divided by the number of elements in the sample. The calculation is made using the built-in standard deviation calculation function in Microsoft Excel (STD). According to the criteria of the VASCOG International Association of Vascular Behavioral and Cognitive Disorders: deviation of + 1.5σ corresponds to moderate, 2.5σ - expressed violation of CF As a norm, we used the data obtained in the control group of 23 healthy volunteers, comparable in age, sex (15 females, average age 58 ± 6 years) and the level of education without MRI signs of any brain pathology and the absence of cognitive complaints. For moderate and severe violations of CF, data were collected and processed in 61 patients (65 females, average age - 61 ± 6.6 years) (see table 1). In all patients, the classical risk factors for cerebrovascular diseases were analyzed: hypertension, diabetes mellitus (DM), hypercholesterolemia, obesity and smoking. The degree of hypertension was evaluated according to the recommendations of the working group for the treatment of hypertension of the European Society of Hypertension and the European Society of Cardiology (ESH / ESC 2013): 1st-degree hypertension systolic blood pressure (SBP) 140-159 and / or diastolic blood pressure (DBP) 90-99 mm Hg. Art., grade 2 hypertension - SAD 160-179 and / or DBP 100-109 mm Hg, grade 3 hypertension - SAD ≥180 and / or DBP≥110 mm Hg. SD was assessed qualitatively by its presence / absence. Hypercholesterolemia was defined as a randomly detected laboratory increase in cholesterol (> 6.2 mmol / L) or compensated figures during treatment. Obesity was diagnosed based on measurements of body mass index (BMI).

According to the test results, patients were divided into monofunctional and multifunctional CR. When determining the type of CR, the recommendations of VASCOG (2014) on the equivalence of memory impairments and other CFs were taken into account. Among monofunctional (isolated violation of CF) types of CR were distinguished: amnestic with a value of cognitive memory functions of + 1.5σ or + 2.5σ, and UVM indicators for any of the tests used were switchability, inhibition, productivity or working memory, and praxis indicators / gnosis is normal; dysregulatory with a UVM value of + 1.5σ or + 2.5σ, according to any of the tests used - switchability, inhibition, productivity or working memory, and memory and praxis-gnosis indicators are normal and apracto-gnostic with praxis / gnosis value +1, 5σ or + 2.5σ, and the memory and UVM indicators for any of the tests used are switchability, inhibition, productivity or working memory is normal. Among the multifunctional types of CRs, the following were distinguished: amnestic with a memory value of + 2.5σ, and UFM according to any of the tests used - switchability, inhibition, productivity or working memory and praxis / gnosis parameters + 1.5σ; dysregulatory with a UVM value of + 2.5σ according to any of the tests used - switchability, inhibition, productivity or working memory, and memory and praxis / gnosis indicators + 1.5σ; apracto-gnostic with praxis / gnosis + 2.5σ, and memory and UVM indicators for any of the tests used are switchability, inhibition, productivity or working memory + 1.5σ and mixed with memory values, UVM according to any of the tests used is switchability , inhibition, productivity or working memory of both praxis / gnosis + 1.5σ (equal degree of impaired memory, UVM and praxis / gnosis).

et al., Internationlal Society for Vascular Behavioral and Cognitive Disorders. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord. 2014; 28(3): 206-18] о равнозначности нарушений памяти и других КФ и оценки в σ тяжести КР позволило нам количественно оценить функции и определить тип КР исходя из преобладающе или изолированно нарушенной КФ по отношению к другим КФ.Using the recommendations of VASCOG [Sachdev P., Kalaria R,

et al., Internationlal Society for Vascular Behavioral and Cognitive Disorders. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord. 2014; 28 (3): 206-18] on the equivalence of memory impairment and other CFs and the assessment of the severity of CR in σ allowed us to quantify the functions and determine the type of CR based on the prevailing or isolated disturbed CF in relation to other CFs.

In FIG. 1 A, B presents the results of the assessment of individual CF (A) and the components of the UVM (B) in 61 patients with KR. Violations of UVM and memory prevailed both at the stage of RBM (84.8% and 58.7%, respectively) and dementia (100% and 93.3%). Violation of praxis / gnosis was less common and tended to increase as CR increased. Violation of UVM in moderate cognitive impairment (RBM) was represented by difficulties in switchability (57%), inhibition (52.2%), verbal productivity (48%), and decreased working memory (39%). At the stage of dementia, violations of all components of the UVM increased, while the prevailing difficulties of switchability remained. Types of CR differed in CRM and dementia (p = 0.001). In UKR, monofunctional types of CR: amnestic, dysregulatory and apracto-gnostic were noted in 21.3% of patients, polyfunctional: amnestic in 28.3% of patients; dysregulatory in 45.6%; apracto-gnostic in 7.6%; mixed in 26.1%. In dementia, monofunctional types of CR: amnestic, dysregulatory and apracto-gnostic were not detected (0%). Multifunctional: mixed forms were detected in 80% of patients; amnestic in 6.7%; dysregulatory in 13.3% of patients; apracto-gnostic in 5.4%.

Examples of the method.

Example 1

Patient A., a 63-year-old man, turned to the FSBI NCH with complaints of decreased memory for current and distant events. During a neuropsychological examination, the following results were obtained:

1. Memory CF test “memorizing 10 words” and their delayed reproduction amounted to 6 out of 10 words (corresponds to a moderate violation (+1.5 σ)).

2. CF UFM switchability - test for hand-eye coordination (TMT VA) - 68 sec (corresponds to the norm).

3. CF UFM inhibition - Stroop test - the number of responses in 45 minutes was 34 responses in 45 seconds (normal).

4. CF UFM productivity - a test for speech fluency in 60 seconds amounted to - 12 words in 60 seconds (corresponds to the norm).

5. CF UFM working memory - the test for the direct and reverse repetition of numbers was 2 points (corresponds to the norm).

6. CF Praxis / Gnosis - the clock drawing test was 9 points (corresponds to the norm).

Thus, the results of the examination show that the patient has a moderate violation (+ 1.5σ) in the memory test (delayed reproduction of 10 words), with normal results in the rest of the tests. Conclusion: Cognitive impairment, monofunctional amnestic type. When conducting a qualitative neuropsychological examination according to the method of A.R. Luria was also identified as a monofunctional amnestic type.

Example 2

Patient S., a man of 50 years old, turned to the FSBI NCH with complaints of decreased memory, a slowdown in the rate of thinking. During a neuropsychological examination, the following results were obtained:

1. CF memory test "memorizing 10 words" and their delayed reproduction was - 8 out of 10 words (corresponds to the norm).

2. CF UFM switchability - the test for hand-eye coordination (TMT VA) was 101 seconds (corresponding to a pronounced violation (+2.5 σ).

3. CF UFM inhibition - Stroop test - the number of responses in 45 minutes was 31 responses in 45 seconds (normal).

4. CF UFM productivity - a test for speech fluency in 60 seconds amounted to - 8 words in 60 seconds (corresponds to a moderate impairment (+1.5 σ)).

5. CF UFM working memory - the test for the direct and reverse repetition of numbers was 2 points (corresponds to the norm).

6. CF Praxis / Gnosis - the clock drawing test was 10 points (corresponds to the norm).

Thus, according to the test results, it is clear that the patient has deviations in tests for CF UFM switchability and productivity with normal values in tests for other functions. Conclusion: Cognitive impairment, monofunctional dysregulatory type. Neuropsychological qualitative examination by the method of A.R. Luria also confirmed the presence of a monofunctional dysregulatory type in this patient.

Example 3

Patient N., a 54-year-old woman, turned to the FSBI NCH with complaints of memory loss, difficulty orienting in space. During a neuropsychological examination, the following results were obtained:

1. CF memory test "memorizing 10 words" and their delayed reproduction amounted to - 10 out of 10 words (corresponds to the norm).

2. CF UFM switchability - test for hand-eye coordination (TMT VA) was 70 seconds (normal).

3. CF UFM inhibition - Stroop test - the number of responses in 45 minutes was 33 responses in 45 seconds (normal).

4. CF UFM productivity - a test for speech fluency in 60 seconds amounted to - 13 words in 60 seconds (corresponds to the norm).

5. CF UFM working memory - the test for the direct and reverse repetition of numbers was 2 points (corresponds to the norm).

6. CF Praxis / Gnosis - the clock drawing test was 5 points (corresponds to a pronounced violation (+2.5 σ)).

Thus, the test results show that the patient has pronounced deviations in the praxis / gnosis test with normal results in the rest of the tests. Conclusion: Cognitive impairment, monofunctional apractognostic type. Neuropsychological qualitative examination by the method of A.R. Luria also confirmed the presence of a monofunctional apractic-gnostic type in this patient.

Example 4

Patient D., a woman of 70 years old, turned to the FSBI NCH with complaints of decreased concentration of attention and memory. During a neuropsychological examination, the following results were obtained:

1. Memory CF test “memorizing 10 words” and their delayed reproduction amounted to 6 out of 10 words (corresponds to a moderate violation (+1.5 σ)).

2. CF UFM switchability - the test for hand-eye coordination (TMT VA) was 124 seconds (corresponding to a pronounced violation (+2.5 σ)).

3. CF UFM inhibition - Stroop test - the number of responses in 45 minutes was 18 responses in 45 seconds (corresponds to a pronounced violation (+2.5 σ)).

4. CF UFM productivity - a test for speech fluency in 60 seconds amounted to - 14 words in 60 seconds (corresponds to the norm).

5. CF UFM working memory - the test for the direct and reverse repetition of numbers was 2 points (corresponds to the norm).

6. CF Praxis / Gnosis - the clock drawing test was 7 points (corresponds to a moderate violation (+1.5 σ)).

Thus, according to the test results, it is evident that the patient has pronounced deviations in tests for CF UFM switchability, inhibition and a moderate deviation in the test for memory and praxis / gnosis. Conclusion: Cognitive impairment, a multifunctional predominantly dysregulatory type. In the process of conducting a qualitative neuropsychological examination according to the method of A.R. Luria has also been identified as a multifunctional dysregulatory type.

Example 5

Patient K., a 49-year-old man, turned to the FSBI NCH with complaints of decreased attention and memory concentration on current and distant events. During a neuropsychological examination, the following results were obtained:

1. Memory CF test “memorizing 10 words” and their delayed reproduction amounted to 4 out of 10 words (corresponds to a pronounced violation (+2.5 σ)).

2. CF UFM switchability - the test for hand-eye coordination (TMT VA) was 78 seconds (corresponding to a moderate disturbance (+1.5 σ)).

3. CF UFM inhibition - Stroop test - the number of responses in 45 minutes was 30 responses in 45 seconds (normal).

4. CF UFM productivity - a test for speech fluency in 60 seconds amounted to - 10 words in 60 seconds (corresponds to the norm).

5. CF UFM working memory - the test for the direct and reverse repetition of numbers was 2 points (corresponds to the norm).

6. CF Praxis / Gnosis - the clock drawing test was 5 points (corresponds to a moderate violation (+1.5 σ).

Thus, the test results show that the patient has pronounced deviations in tests for CF memory and moderate deviations in tests for CF UFM switchability and CF praxis / gnosis. Conclusion: Cognitive impairment, a multifunctional predominantly amnestic type. In the future, when conducting a qualitative neuropsychological examination according to the method of A.R. Luria was also identified as a multifunctional amnestic type.

Example 6

Patient B., male, 63 years old, turned to the FSBI NCH with complaints of memory loss, difficulty orienting in space. During a neuropsychological examination, the following results were obtained:

1. Memory CF test “memorizing 10 words” and their delayed reproduction amounted to 6 out of 10 words (corresponds to a moderate violation (+1.5 σ)).

2. CF UFM switchability - the test for hand-eye coordination (TMT VA) was 86 seconds (corresponding to a moderate disturbance (+1.5 σ)).

3. CF UFM inhibition - Stroop test - the number of responses in 45 minutes was 21 responses in 45 seconds (corresponds to a moderate violation (+1.5 σ)).

4. CF UFM productivity - a test for fluency in speech for 60 seconds amounted to - 11 words in 60 seconds (corresponds to the norm).

5. CF UFM working memory - the test for the direct and reverse repetition of numbers was 2 points (corresponds to the norm).

6. CF Praxis / Gnosis - the clock drawing test was 4 points (corresponds to a pronounced violation (+2.5 σ)). Thus, according to the test results, it is evident that the patient has moderate violations in the CF memory test and CF UFM tests of switchability, inhibition, and pronounced violations of CF praxis / gnosis. Conclusion: Cognitive impairment, a multifunctional predominantly apractic-gnostic type. Neuropsychological examination by the method of A.R. Luria also confirmed the presence of a multifunctional apracto-gnostic type in the patient.

Example 7

Patient T., a 57-year-old woman, turned to the FSBI NCH with complaints of decreased concentration of attention and memory. During a neuropsychological examination, the following results were obtained:

1. Memory CF test “memorizing 10 words” and their delayed reproduction amounted to 6 out of 10 words (corresponds to a moderate violation (+1.5 σ)).

2. CF UFM switchability - the test for hand-eye coordination (TMT VA) was 80 seconds (corresponding to a moderate disturbance (+1.5 σ)).

3. CF UFM inhibition - Stroop test - the number of responses in 45 minutes was 29 answers in 45 seconds (corresponding to a moderate impairment (+1.5 σ)).

4. CF UFM productivity - a test for speech fluency in 60 seconds amounted to - 8 words in 60 seconds (corresponds to a moderate impairment (+1.5 σ)).

5. CF UFM working memory - the test for the direct and reverse repetition of numbers was 2 points (corresponds to the norm).

6. CF Praxis / Gnosis - the clock drawing test was 7 points (corresponds to a moderate violation (+1.5 σ)). Thus, according to the test results, it is evident that the patient has disturbances in tests for CF UFM switchability, inhibition, CF memory and CF praxis / gnosis are equally pronounced. Conclusion: Cognitive impairment, multifunctional mixed type. Neuropsychological examination by the method of A.R. Luria also confirmed the presence of a multifunctional mixed type in the patient.

In conclusion, it should be noted that this approach to determining the types of cognitive disorders in patients with cerebral microangiopathy has shown its viability, since it has increased the accuracy and reliability of determining the severity of CR with the refinement of their monofunctional (isolated violation of a certain cognitive function) and multifunctional types.

Claims (2)

A method for determining the types of cognitive disorders in patients with cerebral microangiopathy, including neuropsychological testing, characterized in that during the neuropsychological testing, cognitive functions (CF) of memory by means of a delayed reproduction of 10 words, controlling brain functions (UVM) by testing switchability - test for hand-eye coordination in seconds, inhibitions by the Stroop test: number of answers in 45 seconds, productivity - test for fluency in 60 seconds and working memory - a test for the direct and reverse repetition of numbers in points, while the points are assigned by sequentially reading out two rows of numbers, which are then repeated in the direct and reverse order and with the correct name Two points are assigned 2 points for each numerical series, 1 point is assigned for the correct naming of one number, and 0 points for less than one numerical series, as well as praxis / gnosis - using the clock drawing test, then the severity of the abnormalities of the test results of CF and UVM are assessed sigma as indicated in table 1 of the description, with a deviation of + 1.5σ corresponds to moderate, +2.5 σ - pronounced violation of CF memory, UFM according to any of the tests used - switchability, inhibition, productivity or working memory and praxis / gnos zis, and with a memory CF value of +1.5 σ or +2.5 σ, and the UVM and praxis / gnosis indicators normally determine a monofunctional amnestic type of cognitive impairment, with a UVM value of +1.5 σ or +2.5 σ, and the indicators of memory and praxis-gnosis normally determine a monofunctional dysregulatory type, with a praxis / gnosis value of +1.5 σ or +2.5 σ, and the indicators of memory and UFM normally determine a monofunctional apracto-gnostic type, with a value of +2 , 5 σ, and UVM and praxis / gnosis +1.5 σ determine the multifunctional amnestic type of cognitive multifunctional disorders, with a value of UVM +2.5 σ, and memory and praxis / gnosis +1.5 σ determine the multifunctional dysregulatory type, with a value of praxis / gnosis +2.5 σ, memory and UVM +1.5 σ determine the multifunctional apracto-gnostic type and with the value of memory, UVM and praxis / gnosis +1.5 σ determine the multifunctional mixed type of cognitive impairment.

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